<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">


    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" class="form-control" name="row[name]" type="text" value="{$row.name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Agent_phone')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-agent_phone" class="form-control" name="row[agent_phone]" type="text" value="{$row.agent_phone|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Agent_province')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-agent_province" class="form-control" name="row[agent_province]" type="text" value="{$row.agent_province|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Agent_city')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class='control-relative'><input id="c-agent_city" class="form-control" data-toggle="city-picker" name="row[agent_city]" type="text" value="{$row.agent_city|htmlentities}"></div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Agent_area')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-agent_area" class="form-control" name="row[agent_area]" type="text" value="{$row.agent_area|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Agent_address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-agent_address" class="form-control" name="row[agent_address]" type="text" value="{$row.agent_address|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="statusList" item="vo"}
            <label for="row[status]-{$key}"><input id="row[status]-{$key}" name="row[status]" type="radio" value="{$key}" {in name="key" value="$row.status"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
